Complex Regional Pain Syndromes Clinical Trial
Official title:
Leaving the Wheelchair Behind - Treating CRPS-II With Exposure Therapy Combined With Cortical Interventions: a Series of Case Reports
Consecutive patients with long-standing complex regional pain syndrome II in a lower limb are treated with graded exposure therapy in vivo in combination with methods targeting cortical reorganisation.
Complex regional pain syndrome, CRPS, is an uncommon but often very handicapping chronic
pain syndrome. Most often, a single extremity is affected. The diagnosis is subdivided in
CRPS type I where no nerve injury has been identified, and CRPS type II when a major nerve
injury has been verified. With the exception of spontaneous pain, several of the symptoms
related to CRPS may be connected to the inactivity and immobilization often seen in the
history of CRPS patients.
Exposure in vivo, a form of behaviour therapy where the patient is gradually confronted with
the avoided movements and activities, has been shown safe and effective for patients with
CRPS type I. The present study uses a combination of exposure in vivo and interventions
targeting a supposed cortical reorganisation with the hypothesis that the functional
impairments would decrease, independent of possible changes in pain levels.
Consecutive patients with long-standing CRPS-II, diagnosed according to the Budapest
criteria, in a lower limb are included. Treatment comprises daily graded exposure therapy in
vivo, in combination with methods targeting cortical reorganisation: mirror therapy,
desensibilisation training, and sensory re-education. The treatment is implemented at an
in-patient ward during four plus four weeks, separated by a home training period of 6-8
weeks.
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